Individual
JESSE DAVID WINSLOW RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1185 S ELM ST, CANBY, OR 97013-3935
(503) 723-4660
(503) 266-6649
Mailing address
PO BOX 1517, PENDLETON, OR 97801-0410
(877) 708-1119
(541) 278-8349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA203927
OR
363A00000X
Physician Assistant
Primary
PA203927
OR
363A00000X
Physician Assistant
—
OR
Other
Enumeration date
09/13/2021
Last updated
07/23/2026
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